Subject(s)
Fluid Therapy/methods , Hemodynamics , Laparoscopy/methods , Monitoring, Intraoperative/methods , Oxygen Consumption , Brain Chemistry , Child , Child, Preschool , Female , Humans , MaleABSTRACT
BACKGROUND: Hypotonic i.v. solutions can cause hyponatraemia in the context of paediatric surgery. However, this has not been demonstrated in neonatal surgery. The goal of this study was to define the relationship between infused perioperative free water and plasma sodium in neonates. METHODS: Newborns up to 7 days old undergoing abdominal or thoracic surgery were included in this prospective, observational study. Collected data included type and duration of surgery, calculated i.v. free water intake, and pre- and postoperative plasma sodium. Statistical analyses were performed using the Pearson correlation, Mann-Whitney test, and receiver operating characteristic analysis with a 1000 time bootstrap procedure. RESULTS: Thirty-four subjects were included. Postoperative hyponatraemia occurred in four subjects (11.9%). The difference between preoperative and postoperative plasma sodium measurements (ΔNaP) correlated with calculated free water intake during surgery (r=0.37, P=0.03), but not with preoperative free water intake. Calculated operative free water intake exceeding 6.5 ml kg(-1) h(-1) was associated with ΔNaP≥4 mM with a sensitivity and specificity [median (95% confidence interval)] of 0.7 (0.9-1) and 0.5 (0.3-0.7), respectively. CONCLUSIONS: Hypotonic solutions and i.v. free water intake of more than 6.5 ml kg(-1) h(-1) are associated with reductions in postoperative plasma sodium measurements ≥4 mM. In the context of neonatal surgery, close monitoring of plasma sodium is mandatory. Routine use of hypotonic i.v. solutions during neonatal surgery should be questioned as they are likely to reduce plasma sodium.
Subject(s)
Hyponatremia/etiology , Hypotonic Solutions/pharmacology , Postoperative Complications/etiology , Sodium/blood , Abdomen/surgery , Anesthesia , Area Under Curve , Data Interpretation, Statistical , Female , Humans , Hyponatremia/blood , Hypotonic Solutions/administration & dosage , Infant, Newborn , Infusions, Intravenous , Intraoperative Period , Linear Models , Male , Postoperative Complications/blood , Preoperative Period , Prospective Studies , ROC Curve , Surgical Procedures, Operative , Thoracic Surgical ProceduresABSTRACT
OBJECTIVE: Propofol is commonly used for sedation of children or adult patients in intensive care unit as an alternative to benzodiazepines for the long-term sedation of mechanically ventiled patient. However, the life-threatening complication of propofol-infusion syndrome (PRIS) may in some case occur. The objective of this article is to review the clinical features, physiopathology and management of PRIS. DATA SOURCES: A PubMed database research in English and French languages published until December 2008. Keywords were propofol, propofol infusion syndrome (PRIS), rhabdomyolysis, heart failure, arrhythmias, metabolic acidosis, brain injury, sedation, intensive care. DATA SYNTHESIS: PRIS is a rare and potentially lethal complication, especially if there's no early identification of the syndrome. The physiopathology of PRIS mechanism remains unclear, however a dysfunction of mitochondrial respiratory chain could be involved and potential genetic factor may account. Clinical features consist of arrhythmias, metabolic acidosis, lipemia, rhabdomyolisis, myoglobinuria. PRIS has been described classically in children and adults undergoing a long term infusion with propofol (more than 48 hours) at doses higher than 4 mg/kg per hour. However, it can be observed with lower doses and after shorter duration of sedation. Steroids, vasopressors and low carbohydrate intake act as triggering factors. Early recognition of the syndrome improve patient's outcome. Propofol infusion must be avoided in susceptible patients and another sedative agent should be considered. When using prolonged sedation with propofol, arrhythmia and serum triglyceridemia level should be monitored.
